Maine will receive about $26 million in Medicare funding over the next three years to support a health care reform experiment in doctor’s offices around the state.
The federal Office of Health Care Innovation announced Tuesday that Maine is one of eight states where Medicare will participate in a demonstration project that could change primary care nationwide.
The experiment is intended to prove that doctors and other health professionals can improve health care quality and lower long-term costs by working together more closely and changing the payment system so that it rewards preventive care.
Twenty-six medical practices around the state are already studying the new model of care, known as the patient-centered medical home. The effort has been paid for by MaineCare, insurance companies and large employers through $3-per-patient monthly fees.
Now, Medicare will pay higher up-front fees for enrollees who are served by the medical practices. The Medicare fee will be $7 per member per month, based on its estimated long-term cost savings.
The buy-in by Medicare adds an estimated 40,000 patients to the study and an estimated $26 million to $28 million in funding over the next three years.
“This award helps Maine build on great work already under way to improve how health care is delivered and paid for,” Gov. John Baldacci said in a written statement.
Frank Johnson, executive director of health and benefits for state employees, said the Medicare announcement is “a game changer and communicates to providers that we have turned the corner on reforming the practice of medicine.”
Maine’s project, officially called the Multi-Payer Advanced Primary Care Practice Demonstration, is led by the Dirigo Health Agency’s Maine Quality Forum, Quality Counts and the Maine Health Management Coalition.
Leaders of the effort in Maine say more coordinated and comprehensive primary care will reduce hospitalizations and medical complications, which are driving up health care costs and health insurance premiums.
The 26 participating practices are spread across the state and include Maine Medical Center Family Medicine Center in Portland and Southern Maine Medical Center PrimeCare Physicians in Biddeford.
Other medical practices in Maine, such as Martin’s Point Health Care in Portland, are adopting the medical home model on their own without state or federal support.
Each demonstration practice is putting more resources into preventive care, such as spending more time on exams and education and communicating with the patients more frequently. The practices also are increasing coordination between doctors, nurses, specialists and other providers so they can more closely keep track of patients’ health and treatments.
In return, the practices are getting extra fees that reward them for preventing illnesses. Reform advocates say that under the current health care payment system, doctors are rewarded for ordering expensive tests and treatments.
The practices also are tracking the health and care of their patients to measure any reduction in the rates of hospitalizations or complications.
Leaders of the effort are confident that the enhanced primary care will improve the health of patients in the study. What is less certain is whether the higher up-front fees will ultimately reduce health care costs overall. The study in Maine and other states will help answer that question, they say.
Those involved in Maine’s study, including The Jackson Laboratory in Bar Harbor and Harvard Pilgrim Health Care, called the federal investment a big step toward improving health care in Maine.
Nancy Kelleher of AARP-Maine said she also is convinced that it will reduce costs.
“Everyone knows when they get high-quality care on the front end, less problems occur down the line,” she said.
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Staff Writer John Richardson can be contacted at 791-6324 or at: jrichardson@pressherald.com
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